PROGNOSTIC FACTORS FOR INJURIES AFTER FALLS FROM HEIGHTS Ir.Christodoulou, Chr.Pogonidis, Eug.Xenodoxidou, M.Tsolakis, D.Babalis,L.Borgi, J.Nakopoulos, D.Gymnopoulos SURGICAL DEPARTMENT, SISMANOGLION HOSPITAL, KOMOTINI, THRACE, GREECE

Introduction Falls from heights are common causes of multi-systemic injuries. It is not always easy to foretell the prognosis of these cases because many factors are involved.

Introduction There have been recognized patterns of injuries after falls from heights. It is of great importance for the Emergency Physician to be informed about the mechanism of the injury/ height of fall, not always referred at the Emergencies Room.

Fall prevention has become a scientific field

Falls and fatalities Falls are the leading cause of fatalities in the construction industry. An average of 363 fatal falls occured each year from 1995 to 2005, with the trend on the increase. In 2005, 1152 construction workers died on the job, with 32.4% resulting from falls.

Fall protection era Analysis of fall hazards arising from work methods Specific fall protection plans/programs Compatible fall arrest systems. Supervision of the installation of fall protection systems with Professional Engineers. Training of construction industry workers and supervisors.

OSHA Regulations: Height at which fall protection is required Construction Standard 1926.501 - 503 (Subpart M): 6 feet height Steel Erection Standard 1926.750: 15 feet height

OSHA Grants National News Release 06-1695-NAT September 29, 2006 Contact: ********* Phone: ******* U.S. Department of Labor Awards More than $10 Million in Grants for Safety and Health Training Programs

Climbing safety systems

Imbalance of industry interest with medical investigation on fall from heights Only 136 medical studies since 1965, Most of them case reports….

Purpose of the study To investigate the prognostic factors in injuries after falls from heights.

Methods Retrospective study Period of retrospective study: 1996- 2005 Subjects: 120 casualties admitted in the Surgical Department of our Hospital after falls from heights. Limitations: Falls at ground level were excluded and only falls > 2 meters were included ( 97 patients).

Methods Age: 5 - 77 years old, Median age 37 years old. Sex: 84 men- 13 women Statistical comparisons were made with Χ2 test. A p< 0.05 statistical level was used.

Results The height factor Mean fall height 6,5 metres( range 2,5- 20 metres). The height of the fall was higher than 5 metres in 46 cases. Only 5 patients fell from a height of more than 15 metres.

Results Intoxication was detected in 32 cases. Alcohol 27 cases Drugs 5 cases Both 3 cases Intentional fall ( possibly) 7 cases

Head injuries Brain injuries 85 patients Maxilofacial injuries 15 patients Neurosurgery 8 patients Maxillofacial surgical repair-12 patients. A severe head injury was the main cause for the admission in ICU in 14 patients.

Thoracic Injuries Thoracic injury 27 patients Pneumothorax 6 patients Hemothorax 4 patients Emergent thoracotomy - 2 patients

Pelvic injury Pelvic fractures 15 patients Synchronous retroperitoneal hemorrhage in 13 patients ( severe in 2).

Spine injuries Cervical spine injuries 37 patients Cervical spine fractures 1 patient Thoracic spine 2 patients Lumbar fractures 23 patients Limbs’ fractures 86 patients

Fractures and neurological deficits Fractures were the most common type of injury. Spinal fractures were detected in 23 patients and were associated with neurologic deficits in 3. Orthopedic operations -12 patients.

Abdominal injuries Abdominal injury 11 patients Laparotomy 11 patients

Abdominal operations Solid organ lacerations 9 cases Small bowel perforation 2 cases Bladder rupture 1 case Significant Retroperitoneal hematoma 2 cases

Results 14 patients were admitted in Intensive Care Unit (ICU) (12 days to 5 months) Mortality – 2 DEATHS in the first post traumatic week and + 2 DEATHS happened in the first post-traumatic month( ARDS,sepsis).

Admission in ICU and injuries Severe hemorrhage was present in 9 critically injured patients admitted in the ICU. Head injury was present in all patients entering the ICU.

Death and injuries Severe hemorrhage was present in all lethal cases(4). Head injury was present in the 3/4 deaths All fatal accidents happened after a fall from the fifth floor of a building or higher.

Conclusions The height of the fall correlated with the severity of injury, the need for operation, the length for hospitalization and mortality

Conclusions Most falls occurred from moderate heights. The spinal column was frequently injured ( 35%) and therefore should be thoroughly assessed clinically and with X-rays. Intra-abdominal injuries were most common than retroperitoneal.

Conclusions The height of the fall is a good predictor of injury severity and outcome prognosis.

Also our study adds the result that severe hemorrhage has a lethally worsening impact in trauma cases with brain injuries. Discussion Brain injury is a leading bad prognostic factor, but we conclude that patients with maxillofacial trauma without brain injury have a better prognosis.

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